having me. hello everyone. i'm sue i gharib of the nightly business report live from the wnet studios at lincoln center here in new york. the newtown shooting puts the spotlight on mental health care and access to guns by the mentally ill. there have been reports that adam lanza suffered from asperger's. this is a form of autism. and that he was being treated for some kind of mental illness, but are those things even relevant? we begin this afternoon with a report from the boston station wgbh. >> accused shooter, adam lanza has been described as socially awkward and reclusive with an above average intellect.

it's not clear whether the 20-year-old was ever formally diagnosed with a mental illness, but he was reportedly assigned to a psychologist in high school. still, his actions have spurred a renewed call for change in the way we address mental health issues. >> mental illness shove underneath a rock much we can't do that anymore. >> our nation needs to take a different approach to mental health and we need to speak about it more honestly. just as we need to do other things. >> experts say it's essential to improve access to treatment of mental illness and to increase public awareness to reduce the stigma associated with seeking help. >> all the issues with access to health care generally, one of the most difficult things to get access to is competent mental health care when you need it. first of all, there's a stigma to admitting you have enough of a problem that you need to see somebody. we have to get over this stigma. >> it's one step toward getting more people the help they need and possibly preventing more innocent lives from being lost.

>> within hours of knowing the identity of the newtown shooter, the news media also began reporting that 20-year-old adam lanza suffered from asperger's. this is a form of autism. experts say there is no evidence of links between autism and violent rampages. we have more from reporter jim a roan i, syracuse station wcny. >> i boys of baldwinsville are checking in with their doctor. his 15-year-old twin brother zachary has autism. they share their observations of the last week of school before the holidays at syracuse university. >> i think the biggest thing of dealing with any child who has autism spectrum is patience. you have to be patient. >> people with autism spectrum disorders deal with two common behaviors. they struggle with social interaction. they also tend to engage in repetitive behavior. violence is not linked to autism

spectrum disorders. aggressive behavior can be. but not the sort displayed in the newtown attack. it is not intentional. it is not planned. >> the aggression you read about in the autism spectrum is usually reactive. you tell them they can't do something, they get angry and want to hit you. there isn't any relationship that i'm aware of them having these aggressive impulses in a premeditated way. >> it is reactive and proceeded by disruptive and irritable behavior. researchers find it to be consistent with social and communication difficulties identified with autism spectrum disorders. children on the spectrum do not find it easy to adapt to social structure, such as school. it puts them at risk much being bullied. that raises stress that can lead to angry or raging outbursts. >> you meet people with autism spectrum and you realize that what you heard about in connecticut isn't autism

spectrum. and if it is autism spectrum, it's incredibly small cohort who have other co-occurring conditions. >> to greet kids, doing well in school. they're in inclusion classes, always have been. they have great staff of teachers. they're good kids at home. >> in washington, there were calls for more funding and more attention to mental health after newtown. but those are issues largely managed by the state. from denver, rocky mountain pbs reports now on colorado governor john hickenlooper's plan to increase spending for mental health. >> at the colorado capital in denver tuesday, governor john hickenlooper announced an $18.5 million package of improvements to the state's mental health system including a boost for statewide crisis intervention. >> after the shootings in aurora, we said we wanted to

allow the victims and their families, the wounded victims to process what had happened to them and the families to grieve with some level of peace, the loss of their family members and their closest friends. but we began looking at what things could we do. we're lucky to have many high-skilled providers and a strong infrastructure already in place. but we know that access to services at present is insufficient. and that oftentimes the delivery of those services is fragments. we're very well aware of it. resources for mental health services have declined over the last few years. really, for a longer period of time than that. certainly now more than ever we need to have tough discussions about how to enhance our systems

and to improve the safety of all k coloradans. it's not controversial. there will be discussions and a thorough analysis, but it connects almost all of these terrible tragedies. >> in new jersey, governor chris christie also called for more mental health services and he raised the issue of the stigma of mental illness. here's a clip from an interview with steve adubato on new jersey public tv. >> this moment, should i hope cause us -- should foster is a national discussion about violence in our society. if you don't deal with the fact that this young man was obviously significantly disturbed and for some reason it

appears was not getting any type of treatment or care, until we deal with that issue, you're just some type of ban is not going to fix the problem. if someone is willing to give up their own life, to take the lives of others, it is almost impossible to prevent them from doing so. >> why have we failed so miserably in terms of government's role? >> because there's an extraordinary stigma that's attached to admitting you have a problem. that's whether it's alcohol or drug abuse or whether it's other types of mental illness. there's still such a stigma attached to it, to getting treatment. whether that treatment be conversational, therapy or whether it be prescription medications or a combination of both. that i think even where we offer services as governor, we do offer and pay for a lot of mental health services as a state government, as a federal government. lots of people won't access it

because they feel stigmatized by it. part of this national discussion has to be that mental illness is no different than having cancer or having any other disease. no one would ever think i don't want anybody to know i have cancer so i'm not going to go to the doctor. yet, with mental illness, we treat people differently. that's what we immediate to get over as a society. >> now, one of the country's leading experts on public policy and mental health is the vice chairman of presbyterian hospital. he was the director of the national institute of mental health during the carter and reagan administrations and he's a past president of the american psychiatric association. host of wnet's news magazine metro focus talked with him earlier this week. >> dr. paragraph dis, thank you for joining us. my presh. >> thank you for having me. >> what is the current state of mental health care in this

country? >> it's rather problematic. i say that because some years ago, the federal government took itself out of the concern about mental health services directly and sent money to the states and so you've got many different systems, inadequate services and too many psychiatric patients languishing in hospitals or with no place to go. >> so where do people, especially people with few resources, get psychiatric help now? >> many of them wind up in the emergency rooms of hospitals within this country. i mean, there are still many areas where there are good services. there are places which have housing and mental health services. that's an appropriate thing to do. but the services are inadequate for the enormous volume of psychiatric illness in the country. >> why is it taken so lightly? >> it's not taken lightly, although i would say to your point, it's seen -- it's often handled as a low priority. if you ask a given person, where would you want to put money to

ensure that you don't have cancer, heart disease, a stroke or psychiatric illness, they'll take the others and psychiatric illness is something they think they'll never get. psychiatric illness has always suffered if a tremendous stigma in a sense of diminished priority. some think it doesn't exist and that it's really -- if the person would simply get themselves together, they could overcome whatever the problems are. >> do you know how much we spend now on mental health care? what has changed since you had some control over policy? >> i'm not sure of the right estimate. i wouldn't be surprised if it's into the hundreds of billions. what's changed is when i was at imh, we were in the middle of a program to place a community mental health center around the country, 1500 of them, each taking care of 200,000 people,

300 million people. you would see mental health care being delivered within the average city, suburban town setting. prior to that, psychiatric illness had been often put aside in state hospitals in remote districts so nobody saw patients. there were close to 600,000 people in psychiatric hospitals at the peak, which was the early '60s. if that had ever continued that way, when you think of the expansion of the population, we'd probably have 3 million people or so in psychiatric state hospitals today. those were closed for -- not closed, but they were reduced down dramatically and there have been attempts to find other services. they've not been sufficient. >> why were they reduced? just a matter of money or were there other reasons or philosophical reasons why the state hospitals were closed in. >> the feeling was that you could have a more optimistic approach toward people in state hospitals, which i think was accurate. that some people with treatments that were being developed could function on the outside and many, many do.

the majority of people with psychiatric problems function on a day-to-day basis like any other medical problem. but the state hospitals were seen as not being therapeutic, therefore, a variety of things came together. the vablavailability of new treatments, the rights of people who had mental illness and a feeling they could be treated better out in the community. it was a big change called deinstitutionalization which took place in the late '60s to the '80s. >> i remember that. it had many positive aspects. did we go too far? >> i think we went a little too far. the reason i say that is of if you've got a potentially violent person and the person has psychiatric illness and you think that the person should have acute psychiatric treatment, sometimes at a hospital, some of the barriers to doing that in terms of official law and regulation have been substantial. so there are many families who

lament the fact they've got a youngster who is troubling, dangerous, large, could hurt and their ability to influence that is limited. you've got to wait until somebody does something or definitive that they're going to do something to hospitalize them rather than take inaction. >> since we're talking approximate that and it's an issue in everybody's mind, what don't we know about the link between mental illness and violence that we should know? >> i think, firstly, we should know is that for the most part, mentally ill patients are not violent. more often they're victims of violence than perpetrators. you'll get a certain number who will, that's clear. but mental illness is a disease which often causes people to be timid, suspicious, isolated, afraid of other people, not necessarily coming at them in an aggressive way. having said that, you'll get the occasional instance where somebody will do something

horrendous like we've seen here and it can or may not be linked to a mental illness. the assumption would be if somebody does something as horrendous as this, there's probably some psyche lonl cal problem with the person. >> is there anything about matt is a lesson, an important lesson for the mental health care community? >> i think, yeah, there are a number of lessons. >> please tell us. >> one is that we as a whole community, both family and also the rest of the community, have to be alert to people who look like they're out of sync with normal life so that one might concern yourself about them. that person, that child, that adult, whatever has to be put into contact with people who provide health and mental health care in order to make sure there's somebody helping them and we don't get to this point. >> dr. pardes, a pleasure talking to you. joining us is the chief of police in new windsor, new york and also the president of the

new york state association of chiefs of police. michael, nice to have you with us. you've been hearing a lot of points of view so far on the program. different aspects of the connection between mental illness and violence. from your perspective, your experience as a law enforcement officer, what's your take on this sm. >> as a law enforcement officer and speaking for the criminal justice system in general, we have taken on pretty much de facto, caring for the mentally yil population. that has switched to the criminal justice community. when i say mentally ill, i think it's important to look at mental illness as a spectrum huge with this end having a person going through a divorce who may not be able to sleep at night and receiving valium from a psychiatrist to the schizophrenic off his medication and possibly homicidal individual. that's an extremely small part.

so when you look at the seriously mentally ill group, of that group, most of those people understand they're ill and they understand and stay on medication or treatment that keeps them a productive member of society. it's another sub sect of that resistant to medication, who are shown to be dangerous that are the concerned in drastic incidents like we're seeing in newtown, similar incidences to that. people with long mental illness histories. >> we want to point out it's been noted over and over again in this broadcast, asperger's has never been proven to be tied to violent behavior, even though the shooter in the newtown case was known to have asperger's. >> that's correct. >> let me ask you this from your perspective, what should be done? fragmented on the mental health solution approach. is this the responsibility of families, parents, schools, the government, what do you think?

>> this is not for lack of trying on the part of families. i mean, families try desperately and also with resistance if not outright feeling like walls are put up to stop them from getting help for their loved ones. this is a problem that i believe the answer exists for. we won't stop it but i -- >> what is that? >> court ordered assisted out patient treatment. in order to get into a treatment program, it's very difficult. you have to meet a lot of bars. nobody gets there accidentally. that's a very small amount. in new york state, for instance, there's 20 million population. currently, 1,823 members under kendra's law as it's known in new york state which is court ordered assisted out patient treatment. it's a judge, a doctor, you're a danger to yourself or others or repeatedly hospitalized or can't provide yourself with necessary life sustaining things. the court mandates that you stay on your treatment plan for

period of time to ensure safety in the community. >> that is one solution. how much does that help in the scheme of things? would that stop another adam lanza? >> it's not going to stop adam lanza. not all of these instances happen after a long prolonged illness. a lot of the instances we've seen, these persons have lengthy mental health histories of violence. of repeated hospitalizations. it's a readily identifiable group. 44 state have laws, but none of them use them to the extent that they should to ensure that this doesn't happen. >> let me ask you this. there have been proposals and calls for a national database of mentally ill people. there have been other proposals for access to check mental health records when someone is purchasing guns and firearms. what do you think of those? is that a deterrent? >> i agree, there should be safe checks hike that in place.

one that should be there is similar to the child abuse registry where you had mandated reporters to use the loughner case. he's put out from college for being dangerous, we're afraid of him, you can't come back until you're psychiatrically proven to be safe. what should happen in a case like that, as a mandated reporter, someone should make notification to a county and say that we have a grave concern about this individual's state of mind and then maybe a mobile crisis team can interview this person and find out what state they're in and introduce them to the assisted out patient treatment program and we can avoid things like this. >> the criticism that will come up right away is privacy issues. so how do we balance between individual rights and the needs of a community? >> well, you know, privacy and goes to the stigmatism issue. historically, when you look at the reports and the records,

this very dangerous group end up in jail. they end up arrested and in yale for either minor things along the way or not major things but they end up in jail. what's more stigmatizing to be convicted of a crime and put in jail or to be on an assisted program getting you help to lead a somewhat productive life. that, i think, is -- we can worry too much about privacy where it brings a person to risk. i mean, you wouldn't let your 2-year-old child play with matches. when a person is meant hi to the point that they're incapable of making safe decisions, you have to have familiar y step in and a stops families from having discussions about this with loved ones. >> since you are a cop, i have to ask you about gun policies. would you like to see changes in gun policies? where do you stand on that? >> the chiefs' association has consistently backed a proposal

to reduce the magazine capacity of assault rifle. i personally don't see a need for assault rifles. i mean, i really don't. but i think a step in the right direction is reducing the capacity of the magazine. >> every time there is one of these violent shootings, people call for change. very little happens and you hear each one of these cases, columbine, virginia tech, aurora, now newtown. what is it that average people can do to get real change? what would you recommend? >> well, if you live in one of the 44 states that have an assisted outpatient treatment program, i would make a call. i would find out if your county within the state is using it. if not, were not? if you're in a state that doesn't use it, find out why. >> i'm sure you'll see connecticut move towards that. i would set federal guidelines and say that nationally, we need to have a standard for aisted

outpatient program. it's a small part of the population that has been a yud indica adjudicated as dangerous. i don't think it's unreasonable to take extra steps. at ate state level, there's no reason not to have an assisted outpatient treatment program. many of the state, new york is the only state that has it and says all the counties will set up a system. the rest of the 43, it's voluntary by county. >> it's a complicated issue. we thank you so much michael for coming along and talking to us. we really appreciate it. >> thank you very much. there's a lot more ahead. don't go away. we'll be right back. coming up, talking to children. what do we say and how do we say it weeks after this tragedy? we'll get firsthand stories from around the country and answer some of a parent's most difficult questions.

hello. i'm host of new york and new jersey public television's news magazine, metro focus. the big picture nationally on policies about mental health care become a critical problem at the local level. when disasters and shootings like in newtown happen. joining me is dr. craig katz, an associate professor at the mount sinai school of medicine. dr. katz, thanks for joining us. >> thank you. >> dr. katz, what's the role of government and maybe if you want to talk about local government in particular in providing services and resources to help young people with psychological problems? >> well, the government plays a role in several ways, largely in

funding. making funding available to people who might not otherwise be able to afford mental health services. government sets standards for what the quality of the mental health services should be and tries to regulate the services to make sure they're up to speed. >> are young people getting the help that they need, young people with psychological problems, do you think getting the help they need in the metropolitan area? >> i think on the whole in mental health, we feel that whether young or old, people don't get enough access to mental health care, whether they don't seek it out, don't know they need to seek it out or that the services aren't there or aren't there in a timely enough fashion. >> is there a difference between how government provides the services or the resources in an urban area, as opposed to a suburban area or rural area. >> it tends to drop off outside of cities. in certain parts of the country, there are greater concentrations

of resources as well. there are major shortage areas around the country. >> what do you attribute that to? >> i think it's a combination of factors. i think one is a matter of having resources. two, i think is there needing to be a role for instilling a culture of mental health in many places around the country, perhaps even the majority. mental health is really not something that is sort of in the forefront of the attention of the public. >> right. >> so that affects who seeks it out, who wants to work there as a mental health professional and what funds go there. >> do you think there's a tendency to believe that it's of secondary importance as compared to other health concerns. >> absolutely, i think people tend to think it's secondary, tertiary or don't think about it. probably for a lot of reasons, including that it's not tangible. you can't look at it or see it on an x-ray. >> how can people seeking this kind of help, particularly people with not so many

resources themselves, how can they get that help sm. >> well, a natural place to start is through the doctors that people turn to anyway. family physicians, internists and pediatricians. that's a good place to start. they will usually know local resources. in addition, there's usually a health department, a local county or state health department that has some kind much local 1-800 number or internet resource to get plugged into or information about local mental health resources. >> what's the role of the stigma associated with mental health in having people not seek the help that they want, that they need? >> stigma is an enormous problem. it really may be at the top of the list. >> yeah. >> somewhere close to funding and stigma. >> really? why still is that the case? >> it's a very good question. i mean, i have my thoughts about it. it's something about the way we are made that we try to keep our

weaknesses and our vulnerabilities hidden from others. it's sort of a protective mechanism. it can translate into civilization, sort of playing your cards close to your chest is i guess a valued thing or something that can promote, in a sense, survival or emotional survival. i think it actually back fires though, in the end, because it becomes keeping things in eventually becomes like the metaphor of a pressure cooker that eventually boils over. >> now, you were the supervising psychiatrist of the world trade center worker volunteer mental health monitoring and treatment program. that's a mouthful. i had to read it. i assume that in that capacity, you had to deal with a lot of post-traumatic stress. >> yes. >> how -- are the people who were affected directly by newtown, specifically the young people, how are they likely to be affected by post-traumatic

stress? >> i think the most familiar one is ptsd. that's a problem where people go on feeling too fearful for too long well beyond when the original threat occurred. that also involves feeling disconnected and detached from people in life and a sense that a real loss of hopelessness, perhaps beyond the level demanded even by something as horrible as newtown. and that is sort of what ptsd is. the other problems may be major depression, the most common form of depression is very common after an overwhelming incident like this. that's problems with feeling depressed day in and day out. often associated with a whole host of physical symptoms and changes in the way people think and at worse, suicidealit. maybe teenagers and adults, turn to drinking to cope. >> are you concerned that as the

memory of newtown fades at least for those of us not directly affected by it, the chances for substantive change in providing mental health support will also fade? >> i think we have the hope that the earlier you get in, the more likely you are to help somebody or to head off mental health problems. although we're still hoping that science helps to validate that. that's what we think clinically, intuitively. you do want to get in as early as possible. the larger question is the focus of resources and attention. if you look at the new york city area, we had sandy and now we have this terrible thing happen in our broader area. it's very bewildering to keep up with it. it feels very much like after 9/11, the crash of the american airlines 587 and we had anthrax. it was one thing after another. i do think it's very hard to maintain a sustained attention and you just sort of hope that somebody in government and local mental health, local health are keeping their eye